Thursday, July 2, 2015

REBELLIOUS QI OF THE CHONG MAI

Rebellious Qi of the Chong Mai is a relatively common pathology; it is more common in women than men.  In women, I have seen at all ages, from teenagers to women over 65.  The first mention of Rebellious Qi of the Chong Mai is in chapter 29 of the Nan Jing: “The pathology of the Chong Mai is rebellious Qi with internal urgency [li ji].”

Li Shi Zhen says the same thing: “When Qi rebels upwards, there is internal urgency [li ji] and a feeling of heat: this is rebellious Qi of the Chong Mai.”

Therefore, two symptoms are identified as pertaining to the pathology of rebellious Qi of the Chong Mai:

Li Ji 

Ni Qi 


LI JI  

Li Ji is very difficult to translate.  Li means “internal” while Ji means “urgency, urgent, anxious, impatient, rapid, fast, irritated, annoyed, violent, hot-tempered, hot-headed.”  The pictograph depicts a hand grabbing the heart.

Most modern Chinese doctors agree that “internal urgency” refers to “anxiety” and I agree with this view.  However, some think that “li ji” refers to an uncomfortable, tight sensation from the lower abdomen upwards towards the heart. 

Some translate “li ji” as “tightness” or “abdominal tightness”.  This is also an acceptable interpretation as, with rebellious Qi of the Chong Mai, there may be a tightness of the abdomen and especially one experienced as propagating from the lower abdomen to the heart.  As it often happens with Chinese medical terms, they may have simultaneous translations which may be all valid.

In general, I interpret “Li Ji” as a feeling of vague anxiety and restlessness.  Indeed, anxiety may manifest (in some cases) specifically with rebellious Qi of the Chong Mai.  If it does, it gives important implications for treatment because it means we need to subdue rebellious Qi of the Chong Mai and treat the lower abdomen “stabilizing” the Chong Mai in the lower abdomen.  We can do this very simply with Ren-4 Guayuan and KI-13 Qixue.

NI QI 
I translate the word “ni” as “rebellious” as that is its main meaning in Chinese. Most authors translate it as “counterflow” which accurately describes the pathology, i.e. Qi flowing against its normal direction of flow.

I like to keep the translation as “rebellious” because it is very descriptive of the pathology of Qi going the wrong way and also because the word “rebellious” reflects the Confucian influence on Chinese medicine.

Confucianism had a profound influence on Chinese medicine, as big or even bigger than that of Daoism.  Confucianism is a humanist philosophy that sought the best way to ensure harmony in the family, society and the State.  At the root of this philosophy is the correct behaviour based on ren, yi, li and xiao.  All these terms are extremely difficult to translate but they are roughly “compassion”, proper behaviour, rituals and filial piety.

The “proper” behaviour is based on the six relationships, three in the family and three in society, i.e.

Parents - children
Husband - wife
Elder brother - younger brother
Sovereign - subjects
Teacher - student
Friend- friend. 

Those on the left (in the above list) of these relationships have a duty of care towards those on the right, e.g. parents caring for the children.  Crucially, those on the right have a duty of respect and obedience towards those on the left, e.g. children obeying the parents and subjects obeying the sovereign.  When this respect and obedience is lacking, they are “rebellious”.

It is interesting that the word “ni” occurs very frequently in the Nei Jing.  The opposite of “ni” is “shun” i.e. “following the rules, obeying”.  For example, following the seasons is “shun” and not following them is “ni”.  “Ni” brings disharmony and disease, “shun” brings harmony and health. Thus, in the Confucian perspective, illness is as much an ethical problem as a medical one.  In the context of Qi counterflow, “shun” also means “going in the same direction as”. 

The two pathologies of “Ni Qi”and “Li Ji” cause a feeling of heat in the head and cold feet.  This feeling of heat is neither Full nor Empty Heat: it is simply a Chong Mai disharmony.  The feet feel cold because, as Qi is rebelling upwards, there is less Qi going down to the feet in the descending branch of the Chong Mai.



The schematic diagrams of the Chong Mai on the left illustrate the pathway of the Chong Mai: starting in the Lower Dan Tian in the Uterus area, going down to Ren-1 Huiyin and from here to ST-30 Qichong from where it goes to KI-11 Henggu and follows the Kidney channel up to KI-21 Youmen. It goes to the chest, scatters in the breast and flows up to the throat, chin, around the mouth and into the eyes. A branch descends from ST-30 Qichong on the medial side of the leg to the ankle where it separates: one branch goes to the Kidney channel on the sole of the foot and one to the big toe and the Liver channel.


It should be noted that the rebellious Qi follows the Kidney channel in the abdomen and all the Kidney points from KI-11 Henggu to KI-21 Youmen but its “rebelliousness” depends a lot on the Liver channel which should therefore also be treated.

It is very important to note that, in order to diagnose Rebellious Qi of the Chong Mai it is not enough to have “Li Ji” and “Ni Qi” but it is necessary to have various abdominal, chest or breast symptoms at different levels.

Rebellious Qi of the Chong Mai causes various symptoms at different levels of the abdomen, chest, breast and throat.  It causes primarily fullness, distension or pain in these areas. 

By plotting the pathway of the Chong Mai, we can list the possible symptoms of rebellious Qi of the Chong Mai starting from the bottom. These are illustrated in the Figure below.


 Please note that in order to diagnose Rebellious Qi of the Chong Mai, there should be at least 3-4 symptoms at different levels, for example, painful periods, epigastric fullness, breast distension and feeling of lump of the throat.  If, in addition to these, the patient also has some anxiety, a feeling of heat of the face and cold feet, we can then diagnose Rebellious Qi of the Chong Mai.  If all the symptoms were in the lower abdomen, e.g. painful periods, abdominal fullness and a feeling of masses, then this is not Rebellious Qi of the Chong Mai.

A symptom that would be very distinctive of Rebellious Qi of the Chong Mai is a feeling of energy rising all the way from the lower abdomen to the throat: however, very few patients report such a symptom.

What makes the Qi of the Chong Mai rebel upwards? 

In my experience, this may happen for two reasons:

1)     The Qi of the Chong Mai can rebel upwards by itself due to emotional stress that makes Qi rise or stagnate. This condition is Full and I call it “primary” rebellious Qi.

2)     Qi may also rebel due to a Deficiency in this vessel (of Blood and/or deficiency of Kidney Yin or Yang) in the lower abdomen. In such cases, Qi of the lower Dan Tian is weak and the Qi of the Chong Mai “escapes” upwards. This is a mixed Full/Empty condition and I call this “secondary” rebellious Qi of the Chong Mai. This is more common in women. 

The Lei Jing confirms this second aetiology of Rebellious Qi of the Chong Mai in this passage: The Qi of the Chong Mai rises up to the chest, Qi is not regulated and therefore it rebels in the diaphragm, Blood is deficient and therefore there is internal urgency in the abdomen and chest.”

I think that what I call a secondary Rebellious Qi of the Chong Mai, i.e. the one arising from a deficiency of the Kidneys and of Blood in the lower abdomen is more common.

As for what I call the “primary” Rebellious Qi deriving from emotional stress, this is due to:

Anger
Worry
Fear
Shock
Guilt

Of course emotional stress plays some role also in what I call “secondary” Rebellious Qi of the Chong Mai.

Rebellious Qi of the Chong Mai may be a complicating pathology in various gynaecological conditions, such as premenstrual tension, painful periods and menopausal problems.

For example, if a woman suffered from painful periods with dark and clotted menstrual blood, we would diagnose stasis of Liver-Blood. But if in conjunction with the painful period, she also experienced epigastric and breast distension, nausea and anxiety, then we can diagnose that the Liver-Blood stasis is aggravated by Rebellious Qi of the Chong Mai.

During the menopause, Rebellious Qi of the Chong Mai is also a frequent aggravating pathology. Menopausal symptoms are due to the decline of Kidney-Jing: however, they may be aggravated by Rebellious Qi of the Chong Mai. Indeed, the onset of the menopause itself may trigger off (not cause) Rebellious Qi of the Chong Mai, especially in the presence of the above-mentioned emotional stress.

This is due to the phenomenon by which the onset of the menopause “destabilizes” the Chong and Ren Mai in the lower abdomen: as a result of this, the Qi of the Chong Mai may rebel upwards, especially when it is stirred by emotional stress.


The acupuncture treatment of Rebellious Qi of the Chong Mai is illustrated in the two Figures below.



The numbers in front of the acupuncture points indicate the order of insertion.

As for herbal treatment, it is necessary to nourish the Chong and Ren Mai and subdue Qi.  Li Shi Zhen advocated using animal products to nourish the extraordinary vessel and for the Chong Mai, he used Gui Ban Plastrum Testudinis and Bie Jia Carapax Amydae sinensis. To subdue Qi of the Chong Mai he recommended:

Xiao Hui Xiang Fructus Foeniculi
Yan Hu Suo Rhizoma Corydalis
Xiang Fu Rhizoma Cyperi
He Huan Pi Cortex Albiziae
Ban Xia Rhizoma Pinelliae preparatum
Dan Shen Radix Salviae miltiorrhizae
Hou Po Cortex Magnoliae officinalis
Zi Su Ye Folium Perillae


The Women’s Treasure remedy Penetrating Vessel is based on the herbs by Li Shi Zhen and it is designed to treat Rebellious Qi of the Chong Mai. 

Monday, June 1, 2015

YIN DEFICIENCY AND EMPTY HEAT

Empty Heat derives from Yin deficiency and the two pathological conditions (Yin deficiency and Empty Heat) are often considered as one.  All modern Chinese books include Empty Heat clinical manifestations under the patterns of Yin deficiency.  For example, under the pattern of Lung-Yin deficiency they will have dry throat and dry cough (Yin deficiency) and 5-palm heat (Empty Heat).

This is not the case in practice as Yin deficiency may last a long time without symptoms or signs of Empty Heat: thus, Yin deficiency and Empty Heat are two separate pathological conditions, even though, of course, the latter derives from the former.

The symptoms of Yin deficiency vary according to the organ involved but generally they will include night-sweating and symptoms and signs of dryness such as dry throat, dry cough, dry lips, dry eyes, dry mouth, thirst with desire to drink in small sips, tongue without coating possibly with cracks.

The symptoms and signs of Empty Heat will include feeling of heat (that is worse in the evening), 5-palm heat (a feeling of heat of palms, chest and soles of feet), malar flush, low-grade fever, a red tongue without coating and possibly a rapid pulse.

The tongue shows conditions of Yin deficiency and Empty Heat clearly.  It is important to understand that, although Empty Heat derives from Yin deficiency, it takes time for it to develop.  Therefore, a patient may display all the signs of Yin deficiency on the tongue for several years without developing Empty Heat and the tongue shows this clearly by lacking a coating (Yin deficiency) but being of a normal colour (no Empty Heat).


In fact, Yin deficiency manifests on the tongue with a lack of coating; therefore, a tongue without coating but of a normal body colour indicates Yin deficiency without Empty Heat. As Yin deficiency aggravates with time, Empty Heat may develop and this turns the tongue red: therefore Empty Heat on the tongue is manifested by a red body colour together with the absence of coating.  One often hears that “in Yin deficiency the tongue is red” (a statement that is tempting to make since “in Yang deficiency the tongue is pale”). This is not so: in Yin deficiency, the tongue lacks a coating; in Empty Heat, the tongue lacks a coating and it is red.

No coating, cracks, normal colour = Yin deficiency

No coating, deep red = Yin deficiency with Empty Heat

A tongue without coating indicates Yin deficiency first and foremost of the Stomach: in addition, it may also indicate Yin deficiency of the Kidneys, Liver or Heart.

That Yin deficiency can occur without Empty Heat is demonstrated by tongue diagnosis as many patients have a tongue that lacks a coating (indicating Yin deficiency) but is not red.

Yin deficiency and Empty Heat are not formed in a short space of time: it takes years from them to develop (the only exception is the Yin deficiency and Empty Heat that may form in an acute way during an invasion of Wind-Heat with Heat penetrating into the Interior). The tongue shows clearly not only the present condition but also the stage it is at: it therefore also shows where it is developing from and what it may lead to.



The three stages of the formation of Yin deficiency based on the tongue are:

1) Rootless coating (this is the mildest form of Yin deficiency)
2) Coating partially missing
3) Coating missing completely

Rootless coating = early stage of Yin deficiency
Coating partially missing
Coating missing completely

Coating missing completely, slightly red
 Empty Heat may develop at any of these stages but it is more likely to develop at the third when the tongue has no coating and it is red.

That Yin deficiency and Empty Heat are two separate pathological conditions is clear also from herbal medicine.  In fact, the herbs and formulae that nourish Yin are in a separate category than the herbs and formulae that clear Empty Heat.

For example, Mai Men Dong Tuber Ophiopogonis japonicis and Tian Men Dong Tuber Asparagi cochinchinensis nourish Yin but they do not clear Empty Heat.  Qin Jiao Radix Gentianae Qinjiao and Qing Hao Herba Artemisiae annuae clear Empty Heat.  When there is Empty Heat of course one combines herbs that clear Empty Heat with those that nourish Yin.

Thursday, April 30, 2015

DYSMENORRHOEA CASE HISTORY

The following is a case history sent by Jason Smith in Madrid

Symptoms
A woman aged 43 seeks treatment for painful periods. The periods last three days and are extremely painful. She feels cold in general, but the cold is more intense at period time. 

The period is regular (30 days), lasts 3 days, with little bleeding, and the color is dark red with small clots. The pain is very intense, and is felt around the area of Ren-4/Ren-3. A warm bottle alleviates the pain along with analgesics. The period has always been very painful, especially after the age of 18.

The tongue has a normal color with a thin coating with root. However, the sublingual veins appeared very dark. This patient was a semi professional swimmer, practicing intensely around the age of 13-18.

Diagnosis
The main pattern is a very obvious case of Cold in the Uterus (nature of pain, feeling of cold and alleviation of the pain by a warm bottle). The Cold in the Uterus led to Blood Stasis, as evidenced by the clots, the dark blood and the dark purple sublingual veins.

Treatment
Following the four phases of the menstrual cycle, I decided to center the treatment on phase 4 (pre-menstrual phase), since this is the best time to expel the pathogenic factor, in this case Cold, from the Uterus.

With acupuncture, I used the Chong Mai, with SP-4 and P-6, and a moxa box around the area of Ren-4.

With herbal medicine, the patient was instructed to take four tablets of the Women´s Treasure Warm the Menses, a variation of the classical formula Wen Jing Tang Warming the Menses Decoction by Zhang Zhong Jing.

After the first period, the pain was reduced by about 50%. After the second period, the pain was reduced by a further 25%. After the third period, and up to date, the patient only feels a very slight pain.

For prevention, the patient was instructed to use a moxa box before the period every now and then, to prevent a new invasion of Cold.

Observations
This is a very clear example of how a pathogenic factor can invade the body (after swimming during her puberty, incidentally a time when Chong, Ren and Du are in a very vulnerable state), and remain for about 30 years. It also shows how, no matter how much time has elapsed, pathogenic factors must be expelled.

It is also interesting to note that this patient reported having many times sexual intercourse without any protection, and despite that, never getting pregnant. This is probably due to the fact that Cold has been blocking the Uterus, and thus preventing fertilization: this is infertility from a Shi (Full) condition.

Further information on Warm the Menses can be found at http://maciociaonline.blogspot.com.es/2015/02/focus-on-remedy-warm-menses.html

Friday, April 10, 2015

MEN: A COMMON MENTAL-EMOTIONAL SYMPTOM

Menis a common symptom in Chinese medicine.  The Chinese character shows a door and a heart inside itThus, it would seem to indicate a heart constricted by a door closing on it.  I translate this  symptom as “a feeling of oppression of the chest”.  Men is very difficult to translate and my translation is an attempt to convey the meaning of this symptom: it certainly does not claim to be the “correct” translation of men as most Chinese medicine terms have multiple, simultaneous meanings.


Chinese patients will actually use the term men: they might say, for example, “I sleep badly, I have a bitter taste and feel men.” In my experience, when a Chinese patients says that it means they are depressed. 

A feeling of oppression of the chest is purely subjective: there is nothing to be observed or palpated  (as there is in feeling of fullness or distension).  Some patients would describe it as a “feeling of weight” on the chest.  Other patients may use the term “tightness of the chest.” 
Men indicates Phlegm or severe Qi stagnation.  Men occurs in the chest or, less frequently, in the epigastrium; it does not occur in the lower abdomen. 
   
The term men first appears in chapter 19 of the Su Wen where it is described as a feeling of fullness of the chest with anxiety and blurred vision.

There is another condition characterized by men called “Rising Men Qi” (Men Qi Sheng), a condition that affects newborn babies.  It is characterized by a feeling of men in the umbilical area, the baby is not crying and has difficulty breathing.[i]

Men is rich in meaning and, in my experience, it describes not only a physical sensation in the chest but also a mental-emotional state of anguish associated with it.  A feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.  I find this symptom very common in the patients we see.

Chronic anxiety often manifests with the feeling of men in the chest and depression may also be accompanied by this symptom.

The presence of men indicates two things: first, that there is Phlegm; secondly, that the Lungs and/or Heart are involved. 

This Phlegm may be of a non-substantial kind and there may not necessarily be any expectoration of mucus (usually there is not).  Its main manifestation is precisely the feeling of oppression of the chest and possibly a Swollen tongue and a Slippery pulse. 



The main points I would use for a feeling of oppression of the chest are Ren-17 Shanzhong, Ren-15 Jiuwei, P-6 Neiguan, LU-7 Lieque and ST-40 Fenglong.

The main prescriptions that could be used are Ban Xia Hou Po Tang (Pinellia-Magnolia Decoction) or Wen Dan Tang (Warming the Gall-Bladder Decoction).



[i]  1980 Concise Dictionary of Chinese Medicine (Jian Ming Zhong Yi Ci Dian           
). People's Health Publishing House, Beijing, p. 476.

Tuesday, February 17, 2015

FOCUS ON A REMEDY: WARM THE MENSES

Warm the Menses is a variation of the well-known classical prescription Wen Jing Tang Warming the Menses Decoction by Zhang Zhong Jing (AD 150-219) from his book Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet).

The original prescription is as follows:

Wu Zhu Yu Fructus Evodiae rutaecarpae
Gui Zhi Ramulus Cinnamomi cassiae
Dang Gui Radix Angelicae sinensis
Chuan Xiong Rhizoma Chuanxiong
Bai Shao Radix Paeoniae
E Jiao Gelatinum Corii Asini
Mai Men Dong Tuber Ophiopogonis 
Mu Dan Pi Cortex Moutan radicis
Ren Shen Radix Ginseng
Ban Xia Rhizoma Pinelliae preparatum
Gan Cao Radix Glycyrrhizae uralensis
Sheng Jiang Rhizoma Zingiberis officinalis recens

The rationale behind it is as follows.  When Cold obstructs the Uterus, it makes Blood stagnate.  When Blood stagnates, new Blood has nowhere to go and it cannot be contained in the Uterus: this induces a deficiency of Blood.

A long-standing Blood deficiency may give rise to some Empty Heat signs, which may mistakenly be interpreted as Heat signs; but the Pale-Purple colour of the tongue clearly indicates that this is not so.  In fact, the original text refers to a parched mouth and lips as the symptoms of Empty Heat from Blood deficiency.

When used for its proper pattern of long-standing internal Cold occurring against a background of Deficiency and leading to stasis of Blood, this formula is very effective. An essential sign for its use is that the tongue-body colour be Pale or Bluish-Purple.

Explanation
- Wu Zhu Yu, Gui Zhi and Sheng Jiang warm the Uterus and expel Cold.
- Dang Gui, Chuan Xiong and Bai Shao nourish and invigorate Blood, which is necessary because the   obstruction of the Uterus by Cold prevents new Blood from taking its proper place there.
- Ren Shen tonifies Qi to nourish Blood.
- Mai Men Dong and E Jiao nourish Blood and Yin.
- Mu Dan Pi clears any Empty Heat which might arise from Blood deficiency.
- Ban Xia harmonizes the Uterus via the Stomach channel to which it is connected through the Chong   Mai.
- Gan Cao harmonizes.

Bluish-Purple left side (Uterus)


Bluish-Purple right side (Uterus)

The following are the ingredients of Warm the Menses:

Wu Zhu Yu Fructus Evodiae
Gui Zhi Ramulus Cinnamomi cassiae
Rou Gui Cortex Cinnamomi 
Dang Gui Radix Angelicae sinensis
Chuan Xiong Rhizoma Chuanxiong
Bai Shao Radix Paeoniae 
Dang Shen Radix Codonopsis
Mai Men Dong Radix Ophiopogonis
Mu Dan Pi Cortex Moutan radicis
Ban Xia Rhizoma Pinelliae preparatum
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata
Shu Di Huang Radix Rehmanniae preparata
Yan Hu Suo Rhizoma Corydalis
Wu Yao Radix Linderae
Yi Mu Cao Herba Leonuri
Du Zhong Cortex Eucommiae ulmoidis

Patterns: Stagnation of Cold in the Uterus, stasis of Blood, Blood deficiency, Kidney-Yang deficiency.

Actions: Expel Cold, warm the Uterus, invigorate Blood, eliminate stasis, nourish Blood, tonify and warm Kidney-Yang.

Indications: very painful periods with pain of a spastic character that is alleviated by the application of heat (such as a hot-water bottle), red or dark menstrual blood with small, dark clots, a pronounced feeling of cold that is aggravated during the period, late periods, irregular periods, infertility from Cold obstructing the uterus, bright-pale complexion, weariness, tiredness, backache, frequent pale urination, occasionally a slight feeling of heat in the face and a dry mouth or lips.
Tongue: Pale, wet.
Pulse: Deep, Tight, slow.

IN A NUTSHELL: expel Cold from the Uterus, invigorate Blood, nourish Blood, tonify Kidney-Yang. The two main indications for this remedy are painful periods and infertility from Cold in the uterus.

The main differences from its classical antecedent are that it tonifies Kidney-Yang and it invigorates Blood.

Bluish-Purple


Bluish-Puirple

END NOTES
1. He Ren 1981 A New Explanation of the Synopsis of Prescriptions from the Golden Cabinet (Jin Gui Yao Lue Xin Jie), Zhejiang Science Publishing House, p. 188.

Friday, January 30, 2015

SEXUALITY IN CHINESE MEDICINE PART 4: SEXUALITY AND EMOTIONAL PROBLEMS

This is the fourth and last part of Sexuality in Chinese Medicine.

Chinese medicine has always stressed the importance of excessive sexual activity as a cause of disease but not insufficient sexual activity.  This has not always been so as, during past dynasties, all sex manuals explicitly say that sexual activity is essential for the health of both men and women.  Indeed, sexual abstinence was viewed with suspicion (as Buddhist nuns were).

The current pruderie of Chinese medicine is clearly a result not so much of the Communist influence but of the Qing dynasty’s Confucian influence.  As we have seen, the Confucianists frowned upon sexual activity and believed that it should be carried out in secret and there should be no public display of affection (as in modern China until recently).

It is important to understand, however, that these rules did by no means imply that sex was a “sin” and woman was the origin of such sin as in the Christian view: nothing could be further from the truth.  The Confucianist abhorrence of sexual philandering was determined mainly by the fear that promiscuity might disrupt the sacred family life, and also by their reverence for the process of human procreation, a solemn process that must not be debased by superfluous amorous play.

Therefore, although the Confucianists considered women as inferior to men, this idea appeared natural to them as that of Earth being inferior to Heaven, thus inferior in a philosophical sense rather than in a concrete sense; it did by no means imply that they hated or despised women, as many medieval Christian thinkers and mystics did.

Moreover, women had their own vested rights, and one of them was the right to satisfaction of their sexual needs.  Although physical contact was strictly limited to the marital bed, there the husband had to give all his women the personal attention he was supposed to deny them as soon as they had left the bed.  The Li Ji (one of the Confucian classics) mentions sexual neglect of one of the women as a grave offence; neither age nor beauty should make the husband deviate from the strict protocol set for sequence and frequency of his sexual intercourse with his wives and concubines.

As we have seen, from the latter part of the Ming dynasty onward, Chinese society became more and more straight-laced and frowning on matters of sex.  We have also seen how Chinese doctors considered lack of sex and sexual frustration as a major cause of emotional stress in women: this is all the more likely to happen as, as we have seen, women’s sexuality is more complex than that of men and they therefore need a man who is expert in the sexual art and foreplay.

Sexual desire depends on the Minister Fire and a healthy sexual appetite indicates that this physiological Fire is abundant.  When sexual desire builds up the Minister Fire blazes up and Yang increases: the orgasm is a release of such accumulated Yang energy and, under normal circumstances, it is a beneficial discharge of Yang-Qi which promotes the free flow of Qi.

When sexual desire builds up, the Minister Fire is stirred: this affects the Mind and, in the terms of organs, specifically the Heat and Pericardium.  The Heart is connected to the Uterus via the Uterus Vessel (Bao Mai) and the orgasmic contractions of the uterus discharge the accumulated Yang energy of the Minister Fire.

When sexual desire is present but does not have an outlet in sexual activity and orgasm, the Minister Fire can accumulate and give rise both to Blood Heat and to stagnation of Qi in the Lower Burner.  This accumulated Heat will stir the Minister Fire further and harass the Mind, while the stagnation of Qi in the Lower Burner can give rise to gynaecological problems such as dysmenorrhoea.

Of course, if sexual desire is absent, then lack of sexual activity will not be a cause of disease.  Conversely, if one abstains from sexual activity but the sexual desire is strong, this will also stir up the Minister Fire but without release.  Thus, the crucial factor is the mental attitude.

With regard to sexual frustration, Qing dynasty’s Chen Jia Yuan wrote very perceptively about some women’s emotional longing and loneliness.  Among the emotional causes of disease he distinguishes “worry and pensiveness” from “depression”.

He basically considers depression, with its ensuing stagnation, due to emotional and sexual frustration and loneliness.  He says: “In women...such as widows, Buddhist nuns, servant girls and concubines, sexual desire agitates [the mind] inside but cannot satisfy the Heart.  The body is restricted on the outside and cannot expand with the mind [i.e. the mind longs for sexual satisfaction but the body is denied it].  This causes stagnation of Qi in the Triple Burner and the chest; after a long time there are strange symptoms such as a feeling of heat and cold as if it were malaria but it is not.  This is depression”.

Although the above thoughts derive from Dr Chen’s clinical experience with servant girls, Buddhist nuns and concubines and should therefore be seen in the social context of the Qing dynasty, they also have relevance to our times as he is essentially talking about sexual frustration and loneliness and his reference to widows confirms this (in old China widows were shunned and seldom remarried).  He perceptively refers to sexual craving agitating the Heart and Mind but not finding a satisfaction in the body: besides sexual frustration, he is also referring to emotional frustration and craving for love.

A constant theme of all this was also SEPARATION: the emotions resulting from separation (sadness and grief) are often at the root of Qi stagnation, not of the Liver, but of the Heart and Lungs and some times development of breast lumps and breast cancer.  It is important to realize that stagnation of Qi comes not only from the Liver but also from Lungs and Heart, especially Lungs.  In fact, even emotions that cause depletion of Qi such as sadness and grief, may cause stagnation of Qi (of the Lungs) because, when Qi is depleted in the chest, it does not circulate well and therefore stagnates.

In the particular case of breast lumps, the stagnation of Qi of the Lungs and Heart is particularly relevant because these two organs and channels are situated in the chest.  Zhu Dan Xi says: “When a woman is worried and depressed, accumulation develops, Spleen-Qi becomes weak, Liver-Qi rebels horizontally, stagnant Qi turns into nodules like turtle eggs, there is no pain or itching.  After 10 years ulcers develop and the disease is called Ru Yan [breast cancer]”.


This statement clearly points out the emotional influence on the development of the disease and also its long term development.  It is important to remember that stagnation of Qi in women is very often secondary and the consequence of a deficiency of the Liver and Kidneys affecting the Ren and Chong Mai.

The “Orthodox Manual of External Diseases” (Wei Ke Zheng Zong) written by Chen Shi Gong in 1617, says: “Depression injures the Liver, pensiveness affects the Spleen, accumulation develops in the Heart, the channel-Qi stagnates and generates [breast] nodules”.

The modern doctor Xia Shao Nong thinks that breast cancer is due to widowhood, breaking of relationships, divorce, death of one’s children, bereavement at a young age from the loss of one’s spouse.  These events, especially if occurring suddenly, upset the mind and lead to Qi stagnation.  It is interesting that all the events this doctor cites have to do with separation.

The Uterus Vessel (Bao Mai) connects the Uterus to the Heart: since the Heart is always affected by emotional problems (because it houses the Shen), this connection explains the profound influence of emotional stress on the menstrual function.  For example, the “Su Wen” in chapter 33 says: “When menstruation does not come, this is due to the Uterus Vessel being blocked.  The Uterus Vessel pertains to the Heart and connects with the Uterus; when Qi rebels upwards towards the Lungs, Heart-Qi cannot flow downwards and the periods do not come”.  “Qi rebelling upwards towards the Lungs” describes in particular the effect of worry, sadness or grief.



Emotional problems are all the more detrimental in women if they occur around the time of puberty.  At this time, a girl’s health is particularly vulnerable and emotional problems will affect her body and mind deeply and with long-lasting effect.  In particular, emotional stress at this time will deeply affect the Ren and Chong Mai creating the imbalances that will cause gynaecological problems later in life.

Emotional stress influences menstruation by affecting the movement of Blood by Qi.  In fact, the first effect of emotional stress is to impair or alter the circulation of Qi by depleting Qi, making Qi stagnant or making Qi rebellious.  Each of these pathologies will affect Blood which follows Qi and becomes deficient, stagnant or rebellious.

The “Golden Mirror of Medicine” says: “Women are frequently affected by worry, pensiveness, anger or depression: these make the Blood move, stop, rebel or conform, which is all due to Qi movement”.

Qing dynasty’s Chen Jia Yuan wrote with regard to worry: “Worry injures the Lungs and pensiveness injures the Spleen, when these two organs are injured Qi and Blood stagnate, there is a feeling of indignation, palpitations, a feeling of oppression of the chest and amenorrhoea”. This passage confirms that stagnation of Qi affects not only the Liver but also that amenorrhoea may occur from stagnation as well as from a deficiency.

Thus, considering the social position of women in ancient China and the frequency of the above-mentioned emotional and sexual frustrations, it is no wonder that Qi stagnation (not always of the Liver) occupies such a central place in women’s pathology, and we can also conclude that emotional stagnation in women was often the result of sexual frustration, separation and loneliness: these are the recurrent “anger” in Chinese medicine books.

This is essentially the clinical meaning and application of Xiao Yao San.  As sexual frustration in women is fairly common in our society (often deriving from men’s sexual inadequacy or inexperience), Dr Chen’s observations on the influence of sexual frustration on stagnation of Qi and depression acquire particular relevance.  This is often a cause of disease somewhat akin to emotional stress.

However, Xiao Yao San may work less well in modern women who have weaker Kidneys than in the past: there is no point in “moving Qi” is there is no Qi to move.  This is, in my opinion, the reason why Xiao Yao San does not work so well in modern women unless it is modified with the addition of some Kidney tonics.

                                       CONCLUSION

What have we got to learn from Daoist sex? One thing that stands out is how the Daoist sex manuals never mention “love”.  Sex seems to be an exercise in moving Qi, releasing the Minister Fire and exchanging Yin and Yang essences with the partner. Both the Daoists and the Confucianists removed love for different reasons and never mention love (although the old poems do).  The modern Chinese have even removed the “heart” from the “love” ideogram!




Modern character for "love" (ai)




Old character for "love"




Heart (xin)





However, there are some useful lessons for us:

1. Differences between men’s and women’s sexuality: many men could learn from that.
2. Importance of women’s orgasm and sexual frustration as cause of Qi stagnation.
3. Importance of men’s expertise in sexual techniques and foreplay.
4. Blow the myth of simultaneous orgasm and the importance of orgasm in men. If the man is         particularly experienced, the woman could have multiple orgasms before his.
5. Western sexuality fixed on orgasm, hence Western men often unskilled: this causes female frustration.  Modern men can learn from Daoist sex to allow for the difference between Water and Fire and therefore women’s slower response.

END NOTES
1. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi Shu Ba Zhong).  Ancient Chinese Medical Books Publishing House, Beijing, p.152.  Chen’s book, written during the Qing dynasty (1644-1911) was entitled Secret Gynaecological Prescriptions (Fu Ke Mi Fang), and published in 1729.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions (Huang Di Nei Jing Su Wen), People’s Health Publishing House, Beijing, first published c. 100 BC, p.197.

3. Golden Mirror of Medicine (Yi Zong Jin Jian), p.9.

4. Eight Secret Books on Gynaecology, p.152.

Monday, January 12, 2015

SEXUALITY IN CHINESE MEDICINE - PART 3

SEXUALITY AND THE EXTRAORDINARY VESSELS

Human sexuality is closely linked to the physiology and pathology of the extraordinary vessels, especially the Du, Ren and Chong Mai.

The Du and Ren Mai are the expression of Fire and Water respectively with regard to sexuality: the exchange of sexual essences and of Yin and Yang during sexual intercourse takes place through the intertwining of the Du and Ren Mai during intercourse.


Both these vessels arise from the space between the Kidneys where the Yuan Qi throbs: they then flow down to the perineum where they separate, one following the spine up to the brain, the other following the front up to the face and eyes.  However, internally they intersect and both flow through the heart.

The “Su Wen” in chapter 60 has the following pathway for the Du Mai: it starts near the uterus, goes down to the pubic bone, in women to the vagina.  Its Luo channel goes around the vagina, passes to the perineum, then the buttocks, down to meet the Kidney and Bladder channels inside the upper thighs; it then rises up the spine and wraps around the kidneys.  In men it goes around the penis and then the perineum.  We can therefore see that, besides flowing up the back, the Du Mai flows to the genitals and is therefore stimulated by sexual intercourse.



Chapter 60 of the Su Wen also describes an abdominal branch of the Du Mai that starts in the abdomen, goes up to the umbilicus, past the heart, throat, chin, around lips and reaches the eyes.

Some see this “main vessel” as being the Ren Mai.  In fact, what it means is that the Du and Ren Mai are almost like two branches of the same vessel, one Yang and one Yin, intersecting inside.  Li Shi Zhen says: “The Du and Ren Mai are like midnight and midday, they are the polar axis of the body...there is one source and two branches, one goes to the front and the other to the back of the body...we can make connections between them.  When we try to divide these, we see that Yin and Yang are inseparable.  When we try to see them as one, we see that it is an indivisible whole.



Wang Big considered this “main vessel”, not as the Ren Mai but as a branch of the Du Mai flowing with the Ren Mai: “Another branch [of the Du Mai] starts in the lower abdomen, comes up the abdomen, to the centre of the eyes, following the pathway of the Ren Mai.  This is why we can say that the Du, Ren and Chong Mai have different names, but are all the same.”

Thus, the Du Mai embodies the Minister Fire and the Ren Mai Water: the contact of the penis inside the vagina establishes the link between the Du and Ren of the man and woman and therefore the exchange of Yin and Yang sexual essences between them.

Moreover, if the partners also kiss simultaneously, the communication between the Du and Ren is established not only below but also above as the Du Mai ends on the upper gum and the Ren Mai flows to the mouth, thus completing the circle.



THE THREE DAN TIAN
The three dan tians are of course closely linked to the Du and Ren Mai.

Upper Dan Tian: this is variously identified as the point Yintang, Du-20, a point between the eyes, the centre of the brain called “ni wan” or the centre of the chest.  In any case, all these points are either on the Du or the Ren Mai.

Middle Dan Tian: on the Ren Mai, Ren-12.

Lower Dan Tian: generally below the navel, could be Ren-6, Ren-5, Ren-4.

There are actually three Dan Tian on the same level: one anterior on the Ren, one in the middle on the Chong and one posterior on the Du (Du-4).



Some Chinese sex manuals give three different locations for women:

Upper Dan Tian: the breasts.
Middle Dan Tian: the navel itself.
Lower Dan Tian: the uterus.



THE THREE PASSES

The three passes are also along the Du Mai; they are like energetic bottlenecks through which Qi has to pass in its ascent to the brain.  The lower pass is at the coccyx; the middle is in the middle of the thoracic vertebrae; the upper is at the occiput.



THE NINE ORIFICES

The nine orifices in sex manuals are different than the usual ones (eyes, ear, etc.): they are the three dans tians, the three passes and the three points: these last three are Du-20, Ren-1 and the point called niwan (centre of the brain).  The three dan tians, three passes and three points form a circuit which is activated during sexual intercourse.

In the pre-natal life, the Du and Ren Mai are connected, whilst after birth, they are severed.  The connection can be re-established through the two “magpie bridges”, in the mouth (holding pressing the tongue upwards on the palate) and in the anus (by contracting the anal sphincter).  Both these manoeuvres are effected during Ba Gua exercises and the first during Tai Ji Quan and Xing Yi.

THE THREE PEAKS

The Three Peaks are related to the Ren and Chong vessels.  In a woman, the Three Peaks are the mouth, breast and vagina: during intercourse, the man can absorb a nourishing Qi and fluids from these three peaks.

The upper Peak is called Red Lotus Peak and its medicine is called Jade Fountain; the middle Peak is called the Double Lotus Peak and its medicine is called the Peach of Immortality; the lower Peak is called Peak of Purple Agaric, Grotto of the White Tiger or Mysterious Gateway and its medicine is called White Lead or Moon Flower.


PEAK               NAME                                   MEDICINE

Mouth               Red Lotus Peak                     Jade Fountain

Breast               Double Lotus Peak                Peach of Immortality

Vagina              Peak of Purple Agaric           White Lead
                          Grotto of the White Tiger      Moon Flower
                          Mysterious Gateway        



The mouth is related to both Ren and Chong Mai, the breast to the Chong and the vagina to the Ren Mai.  It should be clarified here that the man absorbs the vaginal secretions not through fellatio but through his penis.

The Kidneys and the Ren Mai are related to the salivary glands: the Qi of the Kidneys is stimulated during sexual intercourse, it rises in the Du Mai, flows into the mouth and is transformed into sweet salivary elixir.  This saliva is considered to be a Kidney tonic and should be swallowed while mentally directing it to the Lower Dan Tian.  For this reason, absorbing the woman’s energy and fluids from the Upper Peak is particularly beneficial.